Get Employers Out of the Health-Insurance Equation

If you could change one aspect of the Affordable Care Act, what would it be?

GURPREET DHALIWAL: The Affordable Care Act is a bold step forward in improving access to care. The ACA mandates health insurance for every citizen and legal resident, but it does so by extending the current dysfunctional patchwork of insurance (employment-based, individual, state and federal government). An equally bold step would have been to gradually phase employers out of the health-insurance business, eventually leaving only individual and government insurance programs to fulfill the mandate. Employment-based health insurance is a historical artifact that burdens small and large business, limits employment options for workers, and adds excessive complexity to the health-care system and the labor market. We are the only country in the world where the loss of a job equals the loss of both income and health insurance for a family at the same time.

Dr. Gurpreet Dhaliwal is an associate professor of clinical medicine at the University of California, San Francisco, and a staff physician at the San Francisco VA Medical Center.